Lecture 9: Upper Extremity Flashcards
what are the 2 main types of strokes
Ischemic
Hemorrhagic
what are the two types of ischemic strokes
Thrombosis: Blood clot
Embolism: Dislodged platelets, cholesterol, or other material that travels in bloodstream and blocks a vessel
what is a Hemorrhagic stroke
rupture of blood vessels
* Aneurysm
effects of a stroke are determined by what
the location of the stroke
what part of the brain does the anterior cerebral artery supply blood to
front part of brain
what part of the brain does the middle cerebral artery supply blood to
lateral part of brain
what part of the brain does the posterior cerebral artery supply blood to
posterior part of brain
what are the 4 main symptoms of an anterior cerebral stroke
contralateral sensorimotor deficit of foot and leg
arm paresis
gait ataxia
perservation
what are the 4 main symptoms of a middle cerebral stroke
contralateral sensorimotor deficit of face, arm, leg
contralateral semi-spatial neglect or inattention
aphasia
dysarthria
what are the 6 symptoms of a posterior cerebral stroke
nausea and vomiting
vertigo
ataxia
weakness
sensory loss
dysarthria
what joint is the most susceptible to changes post stroke and why
glenohumeral joint
it relies on muscles and tendons to keep it in place
what 4 things causes static stability of the shoulder joint
muscles
joint capsule
joint geometry
ligaments
which 2 groups of muscles create the dynamic stability of the shoulder
Scapulo-humeral Muscles (Rotator Cuff & Deltoid)
o Maintains the humeral head in the glenoid fossa
Scapulo-thoracic Muscles (Serratus Anterior)
o Moves scapula on rib cage (important for reach)
dynamic stability of the shoulder relies on which 3 things
Optimal alignment of the scapula
Correct Glenohumeral orientation
Length-tension relationship of muscles
Arm elevation requires which 2 types of motion
Scapulohumeral motion
Scapulothoracic motion
what is the purpose of Scapulothoracic motion
This significantly decrease the shearing effect between the humeral head and the glenoid
what is the purpose of Scapulohumeral motion
This allows the glenoid fossa to be positioned directly under the humeral head during the end ranges of abduction to increase joint stability
what are the 3 Prime movers for shoulder flexion
0 degrees > 15 = supraspinatous
15 degrees > 90 = deltoid
90 = serratus anterior
when is scapular rotation the greatest
between 80 - 140°
how can a stroke cause shoulder subluxation
muscles supporting the shoulder are not ‘working properly
This causes INSTABILITY in the glenohumeral joint
what is the most common type of subluxation in stroke patients
inferior subluxation
what does an inferior subluxation look like
lateral trunk flexion to weak side
scapula is downwardly rotated
which stroke is the most likely to cause hand and arm deficits
middle cerebral artery strokes
What 3 post-stroke impairments directly impact the upper extremity?
Impaired motor control (upper extremity AND TRUNK)
impaired sensory perception
shoulder pain
what is typical posture post stroke of head
lateral flexed toward involved side, rotation away from involved side
what is typical posture post stroke of the upper extremity
scapular depression and retraction,
shoulder adduction and internal rotation,
Upper extremity flexion
forearm pronation,
what is typical posture post stroke of the trunk
posterior pelvic tilt, possible rotation, lateral flexion toward involved side
what is the continuum of muscle tone
flaccidity
hypotonia
normal
spasticity
rigidity
is an increase in muscle tone always bad?
no. we naturally have temporary increases of muscle tone when we’re in pain or nervous
what is spasticity
velocity-dependent increase in tonic stretch reflexes
tight one direction, moves quickly back in other direction
what is rigidity
Heightened bi-directional resistance to passive movement of the limb (non velocity dependent).
what is the cycle for tone
increased spasticity
leads to immobilization and disuse
leads to contracture
this loops
what is the impact of tone on function
Ranges from minor effects on the quality of movement to significant difficulties for caregiving and ADL
what is the presentation of tone post stroke
U/E Flexor Synergy
what are the 3 impacts of impaired sensation
Sensory feedback
Response or urge to move
Functional use even with intact motor function
what is Hemiplegic Shoulder Pain
Shoulder pain present at rest or during movements on the hemiparetic side after stroke with no history of trauma or injury
A symptom, not a diagnosis
shoulder pain is correlated with what 3 things
loss of external rotation
lack of biomechanical alignment
spasticity
what is the expectation of recovery of Hemiparetic UE Function
initially ~30% of stroke survivors have severe UE motor impairments
30-66% have no improvement
25% of partial recovery
5-20% have full recovery
